O3303: Pediatric High Frequency Percussive Flow Ventilation (HFPFV) Transport: A Case Series

Background: Hospitalized pediatric patients responding to, or candidates for high frequency ventilation +/- inhaled nitric oxide (iNO), may benefit from transport HFPFV +/- iNO. Neonatal transport HFPFV is often deployed to rescue neonates with severe cardiorespiratory failure (TXP-2D, Percussionaire-Sentec, Sandpoint, ID) with HFPFV-approved iNO delivery (Aeronox, International Biomedical, Austin, TX). Pediatric transport HFPFV (Sinusoidal Bronchotron, Percussionaire-Sentec, Sandpoint, ID) is rarely deployed. We describe the impact of transport HFPFV on a series of pediatric patients.

Methods: We performed an IRB approved retrospective case review of HFPFV+/- iNO pediatric transport candidates from our databases. We described patient demographics and severity scores based on available SpO2/FiO2 Ratio (SF) or oxygen saturation index (OSI); OSI = (MAP x FiO2 x 100)/SpO2. We report team member observations about challenges and opportunities in HFPFV-iNO deployment for critically ill pediatric patients.

Results: 171 transported pediatric respiratory failure patients required invasive mechanical ventilation (IMV) from Dec 2018 to Dec 2022. 8 of 171 IMV patients (4.7%) were considered candidates for HFPFV-iNO. The mean age of HFPFV-iNO candidates was 4 years (Range 2 months to 17 years), 50% were younger than 1 year of age, and 62% were female. Request to departure times often approached 2 hours, largely from need to mount HFPFV-iNO systems on standard stretchers. The median length of time from transfer request to team arrival was 178 minutes (IQR 149.5-294.5) and scene time was 139.5 minutes (IQR 118.5-155.8). Of the 8 patients identified, 7 patients were on high frequency oscillator ventilation (HFOV) and 75% were on iNO at the referring hospital. All HFOV patients were transitioned to pediatric transport HFPFV+/-iNO. One patient on IMV could not be transitioned to HFPFV for transport. Transfer interval available SF and OSI are in TABLE. Intra-transport pulse oximetry ranged from 85% to 100%. One patient required an additional vasoactive infusion prior to departure. There were no cardiopulmonary resuscitative events, unplanned extubations, or pneumothoraces requiring needle decompression during transport. One patient needed extracorporeal membrane oxygenation post transport.

Conclusion: The interfacility pediatric transport of severely hypoxic respiratory failure patients with HFPFV-iNO maintained or improved the clinical status if they were on HFOV. We speculate that the request-to-departure time interval could be improved with pre-mounted Pediatric HFPFV-iNO systems. Transport HFPFV+/-iNO in our case series was safely performed with a stable or enhanced clinical course across the spectrum of pediatric ages. This modality can optimize patient transport to advanced cardio-pulmonary treatment centers.